With the support of all leaders a of my Department and the Hospital, and with the helpof the International Society for Emergency Management Medical Committee (TEMC) and the Beijing Huatong Guokang Foundation (BHCF), I had the honor of participating in the 12th Medical Personnel Program at St. Anthony's Hospital in Chicago, fromDecember17,2019 to March 12, 2020.After a 13-hour long flight, we arrived in Chicago, the nation's third-largest city, for a three-month study at St. Anthony's Hospital. During that period, my study direction is mainly in critical medicine, I learned a lot in critical medicine,and also in United States health resources allocation, the training of American doctors, and other fields.
The St. Anthony's Hospital is a public Catholic-sponsored hospital in the early twentieth century. After a hundred years of rebuild and perfection, It became a teaching, scientific research, clinicalmultifunctionalcomprehensive hospital. St. Anthony's Hospital wasfounded in 1896,whichhas more than 20departments, with170beds and 1,562 employees (373 doctors, 291 nurses and 898 others employees). They treat more than 7600 patients a year, the annual operation more than 3100, the inpatient number is 5583, the number of outpatients 136972, treatment of 924 diseases.In keeping with the "all for one,one for all" service philosophy - regardless of nationality, religious beliefs and those who don’t have the ability to pay all can get hospital service.Although the size of the hospital is only in second level, but the medical technology and clinical care is with most of the United States triple-A hospital homogenization, patients in the hospital access to services and medical experience is no less than a triple-A Hospital.
At St. Anthony's Hospital I mainly cycle in the emergency department and ICU,and my dailyschedules are08:00 - 09:00 we do Morning pre-shift meetings, at 09:00 - 12:00 to attend the department round, 12:00 - 12:30 Follow the department director or specialist round, 13:00 - 13:30 lunch, 14:00 - 16:00 we attend the institute in the hospital,During the three-months observing process, there are the following feelings.
Their management is very good,St. Anthony's fine management reflected in many aspects, but what impressed me most is their standardized management details, advanced facilities and equipment, as well as the improvement of the process, the medical staff need to do is as a "fool" to follow, so that in any case, the staff can rely ontheprocessspecificationtableto carryoutfool-like operation,and reduceerrors.
Although it is a smallhospital, but their equipment is perfect and advanced, and very humane. General disease department patients who needs electrocardiogram are using portable monitoring device, palm size placed in the patient's pocket, convenient for patients to get out of bed, while the two nurse stations and corridors in the ward have a central monitoring display, all cardiac patient data displayed on it, so the staffs are easy to observe. Fully automatic function bed,both-side of thebed have position adjustment button, according to the need to choose a variety of positions, they can raise the head of the bed has an automatic angle measuring instrument, and the height of thebed medical staff can use the foot switch control for adjustment, the length of the bed can be extended if needed. Each bed and sheet element has a remote control, the patient can switch the bedside lamp, control the TV,and even have a translat machine,very easy to control.resuscitation cartis a very important weapon tosave the patient's life, although it‘s a small hospital, St. Anthony'sresuscitation cartfunction is very powerful, with UPS function, defibrillator, negative pressure function, oxygen cylinders and other equipment in one, can be used anywhere and quickly in the hospital.
In addition to doctors, nurses, physician assistants, nurse assistants, there are a variety of technicians: respiratory therapists (RT),physiotherapists，operating room technicians (ORT), Surgery Asstent, pharmacy technicians, case managers, social workers, etc. Professional segmentation, make the responsibilities more clearer, work more efficient，for example, assistant nurses can not work as nurses, the same pharmacist and pharmacy technicians work in different roles, and so on. And also professional segmentation can saving more human resources, because the salary of different positions is very different, and staff want to improve salary, they must learn to improve their academic and promotion assessment, so that they work and study is more proactive, and gain more experience of professional value on their job.
Drug safety is an important point in patient safety management, hospital is very careful in the management of using drugs, relying on the science and technology to improve safety and also reduce the burden of health care workers. The United States is very strict on drug use, the inpatient ward use very few types of intravenous fluids，oral medicine andintramuscularinjection is a litter bit more, all the patient's intravenous medicine are controlled by the drug configuration center, they sent it to the ward. The drug storage room in the ward needs a password to enter, the drug is stored in a drug cabinet, they need fingerprint identification and password to open it to ensure the safety of the drug, it could automatically generate using records. In theiroperating system, any durg, clicking on the link can quickly appear the corresponding instructions fordrug use. Each drug,even a single oral medicine, has aQR code. Before using a drug, the nurse must scan the QR code on the drug, only the drug is consistent with the drug prescribed by the doctor to identify and execute, this method almost eliminates the possibility of using the wrong drug.
They have a well-executed notion of " to cure sometimes, to relieve often, to comfort always"andthere are always people comforting patients,St. Anthony's Hospital is used to be amissionary hospital, the hospital has a church, where priests and nuns work here, called Pastoral Care, to help patients and families in need. Every day in the church there are clergy to hold a ceremony, if there are family members because of the serious illness of their loved ones dead, you can seek psychological support there, the heart to get peace. There are even therapy dogs to comfort patients.
During the observing in SAH,I was so impressed by the standard prevention of medical staff, entering the room and leaving the room we need handsterilize, wearing gloves before any operation contact with the patient, removing the gloves after handsterilize, no one check, no supervision, everyone abide by the rule, because this is the custom. On the first day we went to the ward, the teacher gave us a tip. The importance ofhospital infection control, staff compliance is one side, the other side is the hospital‘s sense of prevention and control facilities. Each ward is equipped with different types of gloves, disinfection wipes, large sharp collection box, hand disinfection fluid, in all part ofhospital corridors, elevator spouts, hand washing areas and other public areas. And we could see hand hygiene, cough etiquette education everywhere, inside and outside of the wards , the medical cabinet has disposable gloves, masks, syringes, alcohol disinfection cotton paper, and reusable bed sheets, cotton blankets and other things, Daily regular sanitation cleaning, the ward is spotless.
At St. Anthony,each patient has a special service team consisting ofdoctors, nurses, social workers, care managers, physiotherapists (PT/OT), etc., and in each weekday, team members meet to discuss the patient's condition, the next step of treatment, nursing, rehabilitation program, and the difficulties that the patient's social home needs. For example: patients discharged today, then the team members will sit together in the morning meeting, the doctor and nurse tells the patient's disease recovery, medication precautions, etc. whether need the follow-up nurse (visiting nurse). The guardianship unit also has a specialrespiratorytherapist,responsible for thehospital patients airway management, such as emergency rescue intubation and ventilator parameter adjustment, they graduated from high school into the college training for 3 years to enter the clinical work, greatly alleviated the shortage of doctors, very meaningful and valuable work.
The hospital also takes part in the teaching of the clinical and standardized training of the medical students in the 3-4th academic year in different medical college. Including obstetrics and gynecology, emergency department, pediatrics, neonatology, orthopaedics and otherspecialty. The way of teaching is diversified, clinical teacher use showing pictures, videos, questioning, let students think and do case analysis, small lectures and other ways to conduct assessment, clinical skills teacher using demonstration / demonstration method, students simulation operation and practical guidance in the work to complete. The hospitalhas mentors give lectures to medical students every Tuesday, andwe alsojointhem while learningprofessional knowledgeand medicalEnglish,but also have a certain understanding oftheirteaching methods.
Besides, I visited Chicago's prestigious Northwestern Memorial Hospital, which was founded on September 1, 1972, as the oldest affiliate of Northwestern University Feinberg School of Medicine, two of Chicago's oldest hospitals. The combination of Passavant Memorial Hospital (built in 1865) and Wesley Memorial Hospital (built in 1888) is one of the most important academic medical center hospitals in the United States and the largest non-profit private hospital in the Midwest.
Rush University Medical Center is in thefirst class of the Chicago. It is the main clinical base of Rush University and it has a strong clinical capability.Rush University Medical Center in Chicago, is nationally ranked in 5 adult specialties specialties and rated high performing in 3 adult specialties and 6 procedures and conditions. It is a general medical and surgical facility. It is a teaching hospital. This hospital and 170 other hospitals were named the "best hospital in the country."A medical grand round is held every Wednesday at Rush University, every time the subject anddirection is different, but I think every time I have a new harvest.
We also met some ethnic Chinese physicians in Chicago, and they invited us to visit their ownclinics,chat with them,and learn about theprimarycommunity care section of theUnited States.And we also participate in practical consultations about health and medicine in the Chinatown community, which I think is very meaningful.
Three months is a short time,which means that our visit iscoming to an end. In the beginning we are all stranger, then we establish a friendship, from the initial don’t dare to speak, to be ableto usefluentEnglish to jokewith everyone, I think it’s a big harvest. In here, we see the system and process norms, advanced and convenient facilities, dynamic staff, but also see some differences between China and the United States in the health care system, while feeling the Culture of the United States, worth the trip. I'm lucky to have this opportunity to study in the SAH, and I'm thankful to my hospital leaders and the valuable opportunity that TEMC has given. In the future, I hope that I can maintain enthusiasm, adhere to the dream, and constantly learn and use thoseknowledgein my work, take every step, be a better doctor.
